Nurse response times vary with pediatric monitor alarms

Reaching a patient quickly in response to a bedside alarm could be the difference between life and death. A study in JAMA Pediatrics examines the varied response times of nurses to patient bedside alarms based on differing factors.

Bedside monitor alarms, which alert to life-threatening physiologic changes, is the last line of defense in notifying nurses of an emergency yet nurses are slow in reaching the patient. This cohort study included 551 hours of video-recorded care given to 100 children by 38 nurses from July 22, 2014, to November 11, 2015.

A total of 11,745 bedside alarms from the 100 patients found 50 alarms to be actionable. Average response time was 10.4 minutes and varied due to the following factors:

• If the patient was on complex care services, response time was 5.3 minutes compared to 11.1 minutes.
• If family members were absent from the bedside, response time was 6.3 minutes when present versus 11.7 minutes when not present.
• If the nurse had one year or less of experience, response time was 4.4 minutes versus 8.8 minutes for more than a year experience.
• If the nurse had only one patient, response time was 3.5 minutes versus 10.6 minutes for those with more than one patient.
• The response time was 5.5 minutes with no previous alarms versus 10.7 minutes with a previous alarm.
• If there was a lethal arrhythmia alarm the time was 1.2 minutes versus 10.4 minutes without.
• For every hour that passed on the nurse’s shift, response time increased by 15 percent.

“Response time was associated with factors that likely represent the heuristics nurses use to assess whether an alarm represents a life-threatening condition,” concluded Christopher P. Bonafide, MD, MSCE, attending physician at the Children's Hospital of Philadelphia, first author on the study and colleagues. “The nurse to patient ratio and physical and mental fatigue (measured by the number of hours into a shift) represent modifiable factors associated with response time. Chronic alarm fatigue resulting from long-term exposure to nonactionable alarms may be a more important determinant of response time than short-term exposure.”